A 83-year-old woman with a remote history of IgGk monoclonal gammopathy of undetermined significance presented with mild anemia (hemoglobin 11.7g/dL). She had normal serum calcium and renal function. A skeletal survey revealed multiple lytic bone lesions. Serum protein electrophoresis demonstrated a monoclonal IgGκ of 1.3g/dL and free κ light chains of 1385mg/L. 
Bone marrow aspirate showed 16% plasma cells with many intracytoplasmic needle-shaped inclusions, with many mimicking the faggot cells seen in acute promyelocytic leukemia. The myeloperoxidase stain was negative. Fluorescence in situ hybridization showed loss of TP53 with monosomy 14 and 16. A diagnosis of IgGκ multiple myeloma was made, and the patient is now on bortezomib-based regimen with a good response. 
These pseudo-Auer rods inclusions are a rare finding in some kappa-type multiple myeloma. Their prognostic significance remains unknown.